GULF VETS operations iraqi freedom enduring freedom review

Vol 2 No 1 Information for Veterans Who Served in Iraq and Afghanistan February 2005 and Their Families

Perlin on Challenges Facing VA in 2005 Foremost among the challenges we face in 2005 is our continuing effort to improve the service we provide to our Nationrsquos newest veterans especially those who return ill or injured from Iraq and Afghanistan Excerpt from a letter dated January 4 2005 to all Veterans Health Administration employees from Jonathan B Perlin Acting Under Secretary for Health (the top ranking medical official in VA)

Jonathan B Perlin Acting Under Secretary for Health

New Report on Health Effects from Fuels Combustion Products and Propellants On Monday December 20 2004 the independent

National Academy of Sciencesrsquo Institute of Medicine (IOM) issued the third volume in a series of reports called Gulf War and Health The 500+ page report looked at scientific evidence to reach conclusions about possible connections between certain exposures and health problems

Background In 1998 Congress passed legislation (actually

two separate laws Public Laws 105-277 and 105-368) which directed VA to contract with the National Academy of Sciences for an evaluation of the scientific and medical literature regarding associations between illness and exposure to toxic agents to environmental or wartime hazards and medicines or vaccinations associated with service in the 1990-91 Gulf War While Congress had veterans of the 1990-91 conflict in mind when the legislation was enacted we have included this information on the OIFEF Review because it is likely that many of the more recent veterans had similar exposures

The IOM completed two earlier comprehensive reviews Gulf War and Health Volume 1 Depleted Uranium Pyridostigmine Bromide Sarin and Vaccines and Gulf War and Health (2000) and Volume 2 Insecticides and Solvents (2003) More recently IOM also conducted and released an update of the sarin review entitled Gulf War and Health Updated Literature Review of Sarin The latest release examines the possible health effects

of hydrazines and red fuming nitric acid (used in rocket fuel) hydrogen sulfide oil-fire byproducts diesel-heater fumes and fuels (for example jet fuels and gasoline) (Continued on page 2)

Also in This Issue Two New VA Brochures Highlight Health Care and Assis-tance for Iraqi FreedomEnduring Freedom Veterans 2 Registry Statistics 2 Research Advisory Committee Issues Report VA Announces Additional Funding for Research of Gulf War Illnesses 2 VA Vet Centers Break Down Barriers to Care for Veterans with Readjustment Problems 3 VA Gulf War Programs Recognized for Outstanding Service to Veterans 4 Readersrsquo Survey 5 Conclusions from the First Gulf War After More Than 10 Years of Gulf War Veterans Medical Evaluations What Have We Learned 6 Qrsquos and Arsquos 6 Ionizing Radiation Brief Fact Sheets Available One on Depleted Uranium 7 Whatrsquos New in Depleted Uranium and Health 8 About the ldquoReviewrdquo 8 Clarification 8 Information on VA Disability Compensationhelliphelliphelliphellip9 Address Changes and Duplicates9 WRIISCs Ready to Help OIF and OEF Veterans 10 Delays Enable Increased Printing and Distribution of Newsletter 10

Where to Get Additional Information and Assistance 11

1 Department of Veterans Affairs

(Continued from page 1)Committee Conclusions

The committee established by IOM to consider these exposures concluded that there is some evidence linking combustion products (such as ldquosmogrdquo) and lung cancer The committee found limited evidence linking combustion product exposure and cancers at several other sites (oral nasal laryngeal and bladder) asthma and two reproductive outcomes after exposure during pregnancy preterm birth and low birthweight or intrauterine growth retardation For the propellant components of Scuds only

hydrazines were found to have a suggestive association with lung cancer although these were apparently not used as fuels during the 1991 war in Iraq For additional information regarding these conclusions see their website wwwnapedu

VA Response VA is currently examining the report in the form of

ldquoprepublication copy-uncorrected proofsrdquo to determine what action is warranted by the report that is whether the regulations governing disability compensation or other aspects of VA policy need to be modified in light of their conclusions

Further Reports In accordance with the laws mentioned above IOM

is planning further reports on potential health hazards encountered by US troops in Southwest Asia

Two New VA Brochures HighlightHealth Care and Assistance for IraqiFreedomEnduring Freedom Veterans In December 2004 VA released two brochures for

veterans of the military conflicts in Iraqi and Afghanistan The 6-page Iraqi Freedom publication describes some of the health risks to US service members serving in Iraqi in 2003-2004 and beyond These include environmental health hazards infectious diseases such as leishmaniasis preventive measures pesticides and health deployment stress and deployment-related health effects This fact sheet also includes information about VA

health care services research and disability compensation It also provides information about other sources of informa-tion on this subject The publication is formally known as Information Bulletin (or IB) 10-166 Revised December 2004 Iraqi Freedom Veterans Information for Veterans Who Served in Iraq in 2003-2004 and Beyond and Their Families It replaces a similar brochure on veterans of the first Gulf War It has been available online at wwwVAgov GulfWar Copies can also be obtained at the local VA medical centers VA regional Office and the Vet Centers

The Afghanistan brochure contains similar information about veterans who served in Operation Enduring Freedom It is entitled Enduring Freedom Veterans Information for Veterans Who Served in Afghanistan and For Their Families It is identified as IB 10-71 Revised December 2004 Copies are on the internet at wwwVAgovEnvironAgents and at most VA facilities Both publications are available from the

Environmental Agents Service (131) 810 Vermont Avenue NW Washington DC 20420 Please indicate which publication you want and the quantity sought There is no charge for these publications

Registry Statistics Operation Iraqi Freedom Veterans Initial Examinations through 2003 ndash 80 Initial Examinations through 2004 ndash 1125 Total Examinations including followup examinations through 2004 ndash 1128 Total Examinations in January 2005 ndash 33 Total Agent Orange Registry Examinations ndash 415461 January 2005 Agent Orange Registry Examinations ndash 2115 Operation Enduring Freedom Veterans are not eligible for a Registry examination but may qualify for a similar examination Contact the nearest VA medical center for details

Research Advisory Committee Issues Report VA Announces Additional Funding for Research on Gulf War Veterans Illnesses On the day following Veterans Day 1994 Secretary of

Veterans Affairs Anthony J Principi announced approval for up to $15 million in additional research funding for Gulf War illnesses ldquoWe still donrsquot have a definite cause for Gulf War illnessesrdquo Principi said ldquoThere has to be a reason why some of our veterans came home healthy while others serving along side them did notrdquo Principirsquos announcement coincided with the release of

a 143-page report entitled Scientific Progress in Under-standing Gulf War Veteransrsquo Illnesses Report and Recom-mendations of the Department of Veterans Affairs Research Advisory Committee on Gulf War Veteransrsquo Illnesses The Committee authorized by Section 4 Public Law

105-368 and appointed by Secretary Principi in 2002

22

(Continued from page 1)Committee Conclusions

The committee established by IOM to consider these exposures concluded that there is some evidence linking combustion products (such as ldquosmogrdquo) and lung cancer The committee found limited evidence linking combustion product exposure and cancers at several other sites (oral nasal laryngeal and bladder) asthma and two reproductive outcomes after exposure during pregnancy preterm birth and low birthweight or intrauterine growth retardation For the propellant components of Scuds only

hydrazines were found to have a suggestive association with lung cancer although these were apparently not used as fuels during the 1991 war in Iraq For additional information regarding these conclusions see their website wwwnapedu

VA Response VA is currently examining the report in the form of

ldquoprepublication copy-uncorrected proofsrdquo to determine what action is warranted by the report that is whether the regulations governing disability compensation or other aspects of VA policy need to be modified in light of their conclusions

Further Reports In accordance with the laws mentioned above IOM

is planning further reports on potential health hazards encountered by US troops in Southwest Asia

Two New VA Brochures HighlightHealth Care and Assistance for IraqiFreedomEnduring Freedom Veterans In December 2004 VA released two brochures for

veterans of the military conflicts in Iraqi and Afghanistan The 6-page Iraqi Freedom publication describes some of the health risks to US service members serving in Iraqi in 2003-2004 and beyond These include environmental health hazards infectious diseases such as leishmaniasis preventive measures pesticides and health deployment stress and deployment-related health effects This fact sheet also includes information about VA

health care services research and disability compensation It also provides information about other sources of informa-tion on this subject The publication is formally known as Information Bulletin (or IB) 10-166 Revised December 2004 Iraqi Freedom Veterans Information for Veterans Who Served in Iraq in 2003-2004 and Beyond and Their Families It replaces a similar brochure on veterans of the first Gulf War It has been available online at wwwVAgov GulfWar Copies can also be obtained at the local VA medical centers VA regional Office and the Vet Centers

The Afghanistan brochure contains similar information about veterans who served in Operation Enduring Freedom It is entitled Enduring Freedom Veterans Information for Veterans Who Served in Afghanistan and For Their Families It is identified as IB 10-71 Revised December 2004 Copies are on the internet at wwwVAgovEnvironAgents and at most VA facilities Both publications are available from the

Environmental Agents Service (131) 810 Vermont Avenue NW Washington DC 20420 Please indicate which publication you want and the quantity sought There is no charge for these publications

Registry Statistics Operation Iraqi Freedom Veterans Initial Examinations through 2003 ndash 80 Initial Examinations through 2004 ndash 1125 Total Examinations including followup examinations through 2004 ndash 1128 Total Examinations in January 2005 ndash 33 Total Agent Orange Registry Examinations ndash 415461 January 2005 Agent Orange Registry Examinations ndash 2115 Operation Enduring Freedom Veterans are not eligible for a Registry examination but may qualify for a similar examination Contact the nearest VA medical center for details

Research Advisory Committee Issues Report VA Announces Additional Funding for Research on Gulf War Veterans Illnesses On the day following Veterans Day 1994 Secretary of

Veterans Affairs Anthony J Principi announced approval for up to $15 million in additional research funding for Gulf War illnesses ldquoWe still donrsquot have a definite cause for Gulf War illnessesrdquo Principi said ldquoThere has to be a reason why some of our veterans came home healthy while others serving along side them did notrdquo Principirsquos announcement coincided with the release of

a 143-page report entitled Scientific Progress in Under-standing Gulf War Veteransrsquo Illnesses Report and Recom-mendations of the Department of Veterans Affairs Research Advisory Committee on Gulf War Veteransrsquo Illnesses The Committee authorized by Section 4 Public Law

105-368 and appointed by Secretary Principi in 2002

22

offered 10 findings and more than 4 dozen recommenda-tions including a recommendation that 15 million dollars be specifically added to VArsquos current research and develop-ment budget in support of a Gulf War illnesses research program The funding commitment represents the VArsquos single

largest set-aside of research funding for a specific area of investigation and could make up about 20 percent of VArsquos new research grants awards for FY 2005 During the past decade VA has spent more than $50 million for research into Gulf War veteransrsquo illnesses Much of that research is still ongoing While VA is still examining the report Prin-cipi added he is convinced that there is sufficient justifica-tion for further scientific research ldquoI appreciate the hard work done during the last two and

a half years led by Jim Binnsrdquo Principi said ldquoI know they share my commitment to solve this mystery The full report and additional information about the Committee is available at the following web site wwwVAgovrac-gwvi

VA Vet Centers Break Down Barriers to Care for Veterans with ReadjustmentProblems The below article was drafted by Connie Torres who

spent 10 weeks in the Environmental Agents Service as a Hispanic Association of Colleges and Universities intern in the Summer of 2004 Ms Torres conducted the necessary interviews and wrote the story

For many combatants war is hell No man or woman returns from war the same as when they left And yet they are expected to pick up where they left off to go on as if little has changed As studies have described many veterans need a little --some need a lot --of help readjusting to civilian life For many asking for help may be seen as a sign of weakness instead of recognition that a problem exists and it requires the commitment to do something about it Getting help requires strength Since 1979 VArsquos Vet Centers have been providing

counseling to combat veterans and their families The program now has 206 locations across the Nation and in Guam Puerto Rico and the US Virgin Islands Originally set up to assist Vietnam-era veterans

with their transition from combat to civilian life the programrsquos scope has expanded and currently serves veterans of the Korean War World War II Lebanon Grenada Panama Persian Gulf Somalia Kosovo Bosnia veterans of Operations Enduring Freedom (OEF) Iraqi Freedom (OIF) and operations within the Global War on Terrorism (GWOT)

As the scope expanded so did the number of sites where veterans could get help In 1980 only a year after the centers first opened there were 91 vet centers Ten years later in 1990 there were a total of 201 vet centers Five additional locations subsequently were added VA

Vet Center officials indicate that the program has helped more than 11 million veterans since October 1992

PTSD and Military Service The Vet Centersrsquo priority is readjustment counseling

not only to veterans but also families of veterans Readjustment counseling is aimed at helping veterans adjust to feelings of anger unfamiliarity or isolation that they might experience returning from military service Readjustment problems also can include post-traumatic stress disorder (PTSD) PTSD is a normal reaction that usually comes after

a person experiences or witnesses a trauma such as war or sexual assault Loneliness isolation and change in environment while in combat can also cause PTSD When not dealt with an individual with PTSD can experience a range of sometimes disabling emotions and experiences such as grief anxiety paranoia and difficulty trusting others About 25 percent of soldiers involved in combat and 15 percent of soldiers who were not directly involved in combat experience PTSD or PTSD-like problems Although it is not known when or if an individual

will overcome problems associated with PTSD the Vet Centers make sure that some healing is achieved ldquoWe may not cure people but we make a lot of peoplersquos lives betterrdquo said Dr Jerry Clark Team Leader of the Vet Center in Alexandria VA

Veterans Helping Veterans About 80 percent of the Vet Center counselors

working with veterans are former veterans themselves and 60 percent of them have been in combat According to Dr Clark a Vietnam veteran himself veterans feel more comfortable knowing that they are talking with someone who knows of the ordeals and distress that sometimes comes with being involved in combat ldquoThat counts to themrdquo said Dr Clark As the Centerrsquos Team Leader Dr Clark has the

responsibility of meeting with veterans and seeing that they are placed with counselors who are suited to help them adjust The matching may be based on who the veteran feels more comfortable with which in turn may be based on gender race or similar experience in combat Centers stress the importance of veterans feeling comfortable with the atmosphere and people they are with If thatrsquos accomplished then veterans are more

3

likely to continue with their counseling Dr Clark has been counseling in Vet Centers for 10 years he spent 8 years in Des Moines IA and has been working 2 years in Alexandria VA Dr Clark said that the centers are good areas for social work and that his ldquorespect for the VA populationrdquo influenced him to work at the centers Christopher Reed Veterans Service Representative of

VArsquos Central Office in Washington DC is another exam-ple of a veteran extending his services to help other veterans Reed makes regular trips to Walter Reed Army Medical Center in Washington DC where he spends time with veterans As a ldquomentorrdquo he informs veterans about the various counseling services of the Vet Centers A veteran from the 1993 War in Somalia Reed is aware of the difficulties that sometimes come with adjusting to everyday life Upon his discharge Reed was unaware of the services of Vet Centers Today he believes that if he had known to take advantage of the program it ldquowould have changed my life in several aspectsrdquo Thatrsquos why he makes sure to recommend Vet Centers to those he feels may need the assistance The Centers also provide bereavement counseling to

spouses parents and children of Armed Forces person-nel who died while serving in combat The counsel-ing services for families consist of extensive transition services such as outreach and referral services Like readjusting counseling bereavement counseling is pro-vided free of charge The Vet Centerrsquos programs for veterans include

trauma counseling special populations networking wellness leadership management and transitional assis-tance These are managed through individual group or marital and family counseling medical referrals assis-tance in applying for VA benefits employment counsel-ing guidance and referral alcoholdrug evaluations information and referral to community resources sexual trauma counseling and referral and community educa-tion Participants in Vet Centers often receive additional assistance from VA medical centers or regional offices For additional information regarding this program and the nearest Vet Center call toll- free 1-800-827-1000 or go to wwwVAgovrcs

VA Gulf War Programs Recognized for Outstanding Service to Veterans In March 2004 the Office of Public Health and

Environmental Hazards in VA Central Office sent the first Environmental Hazard Center of Excellence Awards to 13 field facilities The award based on a non-scientific survey mailed in August 2003 gave veterans the opportunity to evaluate the Environmental Health Registry staff

A

Dr Kurt Schlegemilch Director VAMC poses with award winning team at Grand Junction

The veterans receiving the survey were those who had been involved in the gent Orange Gulf War and Ionizing Radiation Registry Program According to

Environmental Agents Service (EAS) Director Dr Mark Brown the award was intended to ldquorecognize outstanding service to veteransrdquo He also emphasized that the facilities that did not receive an award were not criticized In fact overall the responses were positive and those not chosen in this round of awards received many excellent reports from the veterans they serve The survey asked veterans to name a VA Registry

clinician or coordinator that has provided them with ldquooutstanding customer servicerdquo However respondents generally choose to acknowledge the facility rather than a particular individual The facilities received the new award certificate

entitled ldquoEnvironmental Health Center of Excellence Awardrdquo in recognition of the expertise patience and dedication displayed by the VA staff The exceptional centers were

bull VA Medical Center (VAMC) Boise ID bull VAMC Cheyenne WY bull VAMC Durham NC bull VAMC Fargo ND bull VAMC Fresno CA bull VAMC Grand Junction CO bull VAMC Manchester NH bull VAOPC Oakland Park FL bull WG (Bill) Hefner VAMC Salisbury NC bull VAMC San Francisco CA bull VAMC White River Junction VT bull VA Community Based Outpatient Clinic

(OPC) Williamsport PA and bull VAOPC Winston-Salem NC The significance of the award and the uniqueness

in which the recipients were chosen makes the award much more valuable This was the first time veterans were given a survey that allowed them to evaluate the Registry services and staff of their medical center Honorees were unaware of the survey and were overwhelmed to know that the award was based on the evaluation by veterans ldquoIt makes the award much more

44

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________

meaningfulrdquo said Daniel Duffy VAMCrsquos clinical coordinator for Special Programs in White River Junction VT For Cindy Force Network Program Support Unit Manager Environmental Health Coordinator of the VAMC in Durham NC the veteranrsquos input was a positive boost ldquoIt makes you feel as though yoursquove done your job wellrdquo said Force Despite the surprise of the award facilities are aware

of their capabilities which they attribute to the staffrsquos friendliness and knowledge Jim Nelson administrative officer of the VAOPC in Winston-Salem NC described the staff as ldquovery personal and friendly with patientsrdquo two essential qualities other facilities also associated with their success The VAMC in Manchester NH takes great pride in positive feedback it has received ldquoWe seldom have complaintsrdquo said Timothy Dorgan Eligibility Coordinator Recipients of the award also mentioned that because

of their great staff they feel confident that they will receive the award again Program Assistant Marj Doescher of the VAMC in Boise ID acknowledged the employeesrsquo impressive work and offered advice for other facilities Doescher stressed the importance of being aware of programs ldquoKnowing the program and being able to clarify is vitalrdquo said Doescher Susan H Mather MD MPH Chief Public Health

and Environmental Hazards Officer signed each certifi-cate Each one marked with a gold seal was mailed to the Director with the request that it be displayed in an area where it could be easily recognized preferably with the Agent Orange Gulf War and Ionizing Radiation post-ers and newsletters Due to the positive responses the Office of Public

Health and Environmental Hazards looks forward to conducting this survey and offering this special recogni-tion again in the near future ldquoI felt it was a success it was well received by coordinatorsrdquo said EAS Program Analyst Michelle Foster Foster was responsible for arranging the survey and

for announcing the results at the national EAS quarterly conference call A survey is planned for this year and should continue in the upcoming years The above article was drafted by Connie Torres His-

panic Association of Colleges and Universities summer intern in EAS

5

Readersrsquo Survey The editor of this newsletter is seeking feedback on the three issues published to date Please take a few minutes to provide your comments suggestions recommendations and advice for future issues of the newsletter

In completing the brief questionnaire we ask that you not critique the VAhealth care system explain the difficulties you may have encountered in getting financial benefits from VA or discuss your health problems

Rather we want your ideas with regard to the newsletter You are welcome and even encouraged to bring those other problems to our attention in another letter Please send your survey response to Mr Donald J Rosenblum Environmental Agents Service (131) ATTN OIFOEF Survey Department of Veterans Affairs 810 Vermont Avenue NW Washington DC 20420 You can use this paper or write on your own

Thank you in advance for your cooperation

Are you a veteran Yes No

Are you the spouse of a veteran Yes No

Are you a first time reader of this newsletter Yes No

What do you think of the Review _______________

Does it meet your needs Why or why not________

What changes would you like to see in this publication Additions Deletions______________

Additional comments or suggestions______________

For the greatest impact please respond as soon as possible

Conclusions from the First Gulf War The authors are Gregory C Gray formerly director After More than 10 Years of Gulf War Center for Deployment Health Research Naval Health Veterans Medical Evaluations What Research Center San Diego now with the Department Have We Learned of Epidemiology University of Iowa Gary D

Veterans have suffered a wide range of health problems since returning from the first Gulf War However health care registry data and epidemiologic (population) studies of health care use have revealed no unique Gulf War syndrome nor identified specific exposures that might explain these health problems That was a major conclusion of a team of scientists

from the US Great Britain and Canada in a recent issue of the American Journal of Preventive Medicine (Am J Prev Med 200426(5)443-452) They observed that Gulf War veterans have had an increase in injury mental health and multi-symptom condition diagnoses similar to those that have affected other military populations Despite the expenditure in excess of $1 billion in understanding and treating Gulf War veterans during the past decade scientists have been unable to fully understand and explain these diagnoses This paper focused on the health care experience

of veterans included in VArsquos Gulf War Veterans Health Registry Department of Defensersquos Comprehensive Clinical Evaluation Program United Kingdom Ministry of Defencersquos Gulf War Medical Assessment Programme and Canada Department of National Defencersquos Canadian Gulf War Registry Using multiple search techniques the authors reviewed health care usage data from these four national Gulf War Registries The authors suggested that in addition to evaluating

possible therapies for multi-symptom conditions researchers should work to identify risk factors for the development of such conditions They commented that if military personnel likely to develop multi-symptom conditions can be identified early in their service special training and interventions might be used to reduce the impact of these conditions They added that DoD seems to be moving in that

direction in studying military personnel who served in the recent deployment in Afghanistan and Iraq Predeployment in theater and postdeployment data are being evaluated to identify predictors of postdeployment symptom-based illnesses Personnel at high risk of developing multi-symptom conditions may benefit from cognitive behavior therapy coping skill training or other interventions to help them prepare for intensive stresses of war The authors also praised DoD for improved disease

and injury surveillance and freely reporting occurrences that may be associated with military service ldquoSuch close surveillance with rapid public reporting is commendablerdquo

Gaskstetter of the Uniformed Services University of the Health Sciences Han K Kang Director Environmental Epidemiology Service Department of Veterans Affairs John T Graham British Liaison Officer Defence Staff British Embassy and Ken C Scott Deputy Chief of Staff Medical Policy Canadian Forces Individuals with questions or comments for the

authors or who wish to respond to something in the article should address their correspondence to Gregory C Gray MD University of Iowa College of Public Health 200 Hawkins Dr C21K GH Iowa City IA 52242 Dr Gray email address is gregory-grayuiowa edu

Qrsquos and Arsquos The ldquoReviewrdquo occasionally includes a questions-and-

answers feature in which VA officials respond to inqui-ries from readers and others regarding possible health problems and concerns of Operations Iraqi Freedom and Enduring Freedom veterans and their families and about programs initiated by VA and other Federal departments and agencies to help these veterans Dr Mark A Brown Director Environmental Agents Service answered the first question Q Irsquove heard that a parasite Schistosoma haemato-

bium found in Iraq has caused health problems for some Iraqi Freedom Veterans and may eventually lead to bladder cancer Is that correct A Schistososmiasis is found in Iraq but not Afghani-

stan and infection is thought to be not very common Schistosoma haematobium which causes urinary schis-tosomiasis is the only species of Schistosoma reported in Iraq Western personnel would not be at risk of schistoso-miasis unless they waded or swam in infested water We will probably not have many cases of long-term chronic infection with this parasite among OIF veterans because the disease is treatable If schistosomiasis is suspected in a veteran the first step would be to send urine specimens to the laboratory to look for characteristic eggs of this para-site If a veteran had medical evidence of long-term infec-tion with this parasite and they developed bladder cancer then they might have a basis for a compensation claim Another question that has been received from several

sources is Q Are Iraqi Freedom and Enduring Freedom veterans

eligible for Gulf War Registry health examinations offered at VA health care nationwide And what is involved in the Registry exam program

66

A For the answer we turned to Helen Malaskiewicz Senior ProgramManagement Analyst in the Environmental Agents Service and National Registry Coordinator She has been in that position for more than a decade According to Ms Malaskiewicz For Operation Iraqi

Freedom veterans the answer is definitely ldquoyesrdquo We encourage all Gulf War veterans which includes everyone who has served in the war in Iraq to contact the nearest VA medical center for an appointment Under the Registry program VA Environmental Health

Clinicians conduct a comprehensive physical examination Participating veterans are given the following baseline studies a complete blood count blood chemistries enzyme studies and urinalysis A chest x ray is taken if medically necessary Additional appropriate diagnostic studies are performed and consultants are obtained as indicated by the patientrsquos symptoms and physical and laboratory test result Laboratory and other finding are filed in the veteranrsquos permanent record maintained by the VA medical system In gathering each veteranrsquos medical history the

examiner records the time of onset of symptoms or conditions the intensity of symptoms or conditions the degree of physical incapacitation and details of any treatment received The examiner pays special attention to conditions and diagnoses that may be associated with service in the Operation Iraqi Freedom Following the examination the VA Environmental Health Clinician is responsible for personally discussing with each individual veteran the findings of the examination and completed diagnostic studies In addition each veteran will receive a followup letter explaining these finding and advising him or her of future actions or recommendations Operation Enduring Freedom veterans are not eligible

for the Gulf War Registry health exam and may not be included in the Registry However VA health care providers are equally concerned about the medical difficulties that those who served in Afghanistan have experienced and have welcomed concerned Afghanistan veterans to come to VA for a medical examination similar to that offered to Iraqi Freedom veterans Since 1998 VA has been authorized to provide a

broad range of health care services to US veterans who served on active duty in a designated theater of operations which would include Afghanistan Such veterans are eligible for 2 years after leaving the military for VA hospital care medical services and nursing home care for any illness even if there is insufficient medical evidence to conclude that their illness was a result of their combat service Dental services are not

included in the 2-year program What this means is that combat veterans have access to high quality health care at VA medical facilities for 2 years after their separation from military service based on their service in combat without having to prove that their health problems may be related to their combat service or to toxic exposures during their active service After the 2 years have ended the veteranrsquos copay-

ment status will depend on whether the medical condi-tion was officially found by VA to be service-connected or whether the veteran is otherwise qualified for care He or she will be enrolled in the appropriate priority group level For information regarding enrollment see www VAgovelig or contact the nearest VA medical center For locations of VA facilities consult the local

telephone directory under ldquoUS Governmentrdquo listings see wwwVAgov or call 877-222-VETS (or 8387) Additional questions should be sent as follows Mr Donald J Rosenblum Deputy Director Environmental Agents Service (131) Attn OIFEF REVIEW ndashQrsquos amp Arsquos Department of Veterans Affairs 810 Vermont Avenue NW Washington DC 20420 We will answer as many questions as possible

and will not identify the questioner Questions about personal medical problems are not generally considered appropriate for inclusion in the newsletter

Ionizing Radiation Fact Sheets Available One on Depleted Uranium A series of fact sheets known as ldquoIonizing Radiation

Briefsrdquo has recently been prepared and released by the Environmental Agents Service Each stand alone fact sheet covers an aspect or concern of veterans who were exposed to ionizing radiation Included among the Briefs is a 4-page fact sheet on

depleted uranium (DU) suspected by some individuals as the cause of some health problems experienced by some who served in the Gulf War or in Afghanistan Other available briefs provide general information on ionizing radiation describe the ionizing radiation registry discuss the VArsquos disability compensation program identify infor-mation resources on radiation health effects list illnesses linked to ionizing radiation and offer further information on related topics Readers can get the DU brief or any other or all avail-

able ionizing radiation fact sheets from the Environmental Health Coordinator at the nearest VA medical center or from the Environmental Agents Service (131) ATTN IR BRIEFS VA Central Office 810 Vermont Avenue NW Washington DC 20420 Also the Briefs are available online at wwwVAgovIrad

7

Conclusions from the First Gulf War The authors are Gregory C Gray formerly director After More than 10 Years of Gulf War Center for Deployment Health Research Naval Health Veterans Medical Evaluations What Research Center San Diego now with the Department Have We Learned of Epidemiology University of Iowa Gary D

Veterans have suffered a wide range of health problems since returning from the first Gulf War However health care registry data and epidemiologic (population) studies of health care use have revealed no unique Gulf War syndrome nor identified specific exposures that might explain these health problems That was a major conclusion of a team of scientists

from the US Great Britain and Canada in a recent issue of the American Journal of Preventive Medicine (Am J Prev Med 200426(5)443-452) They observed that Gulf War veterans have had an increase in injury mental health and multi-symptom condition diagnoses similar to those that have affected other military populations Despite the expenditure in excess of $1 billion in understanding and treating Gulf War veterans during the past decade scientists have been unable to fully understand and explain these diagnoses This paper focused on the health care experience

of veterans included in VArsquos Gulf War Veterans Health Registry Department of Defensersquos Comprehensive Clinical Evaluation Program United Kingdom Ministry of Defencersquos Gulf War Medical Assessment Programme and Canada Department of National Defencersquos Canadian Gulf War Registry Using multiple search techniques the authors reviewed health care usage data from these four national Gulf War Registries The authors suggested that in addition to evaluating

possible therapies for multi-symptom conditions researchers should work to identify risk factors for the development of such conditions They commented that if military personnel likely to develop multi-symptom conditions can be identified early in their service special training and interventions might be used to reduce the impact of these conditions They added that DoD seems to be moving in that

direction in studying military personnel who served in the recent deployment in Afghanistan and Iraq Predeployment in theater and postdeployment data are being evaluated to identify predictors of postdeployment symptom-based illnesses Personnel at high risk of developing multi-symptom conditions may benefit from cognitive behavior therapy coping skill training or other interventions to help them prepare for intensive stresses of war The authors also praised DoD for improved disease

and injury surveillance and freely reporting occurrences that may be associated with military service ldquoSuch close surveillance with rapid public reporting is commendablerdquo

Gaskstetter of the Uniformed Services University of the Health Sciences Han K Kang Director Environmental Epidemiology Service Department of Veterans Affairs John T Graham British Liaison Officer Defence Staff British Embassy and Ken C Scott Deputy Chief of Staff Medical Policy Canadian Forces Individuals with questions or comments for the

authors or who wish to respond to something in the article should address their correspondence to Gregory C Gray MD University of Iowa College of Public Health 200 Hawkins Dr C21K GH Iowa City IA 52242 Dr Gray email address is gregory-grayuiowa edu

Qrsquos and Arsquos The ldquoReviewrdquo occasionally includes a questions-and-

answers feature in which VA officials respond to inqui-ries from readers and others regarding possible health problems and concerns of Operations Iraqi Freedom and Enduring Freedom veterans and their families and about programs initiated by VA and other Federal departments and agencies to help these veterans Dr Mark A Brown Director Environmental Agents Service answered the first question Q Irsquove heard that a parasite Schistosoma haemato-

bium found in Iraq has caused health problems for some Iraqi Freedom Veterans and may eventually lead to bladder cancer Is that correct A Schistososmiasis is found in Iraq but not Afghani-

stan and infection is thought to be not very common Schistosoma haematobium which causes urinary schis-tosomiasis is the only species of Schistosoma reported in Iraq Western personnel would not be at risk of schistoso-miasis unless they waded or swam in infested water We will probably not have many cases of long-term chronic infection with this parasite among OIF veterans because the disease is treatable If schistosomiasis is suspected in a veteran the first step would be to send urine specimens to the laboratory to look for characteristic eggs of this para-site If a veteran had medical evidence of long-term infec-tion with this parasite and they developed bladder cancer then they might have a basis for a compensation claim Another question that has been received from several

sources is Q Are Iraqi Freedom and Enduring Freedom veterans

eligible for Gulf War Registry health examinations offered at VA health care nationwide And what is involved in the Registry exam program

66

A For the answer we turned to Helen Malaskiewicz Senior ProgramManagement Analyst in the Environmental Agents Service and National Registry Coordinator She has been in that position for more than a decade According to Ms Malaskiewicz For Operation Iraqi

Freedom veterans the answer is definitely ldquoyesrdquo We encourage all Gulf War veterans which includes everyone who has served in the war in Iraq to contact the nearest VA medical center for an appointment Under the Registry program VA Environmental Health

Clinicians conduct a comprehensive physical examination Participating veterans are given the following baseline studies a complete blood count blood chemistries enzyme studies and urinalysis A chest x ray is taken if medically necessary Additional appropriate diagnostic studies are performed and consultants are obtained as indicated by the patientrsquos symptoms and physical and laboratory test result Laboratory and other finding are filed in the veteranrsquos permanent record maintained by the VA medical system In gathering each veteranrsquos medical history the

examiner records the time of onset of symptoms or conditions the intensity of symptoms or conditions the degree of physical incapacitation and details of any treatment received The examiner pays special attention to conditions and diagnoses that may be associated with service in the Operation Iraqi Freedom Following the examination the VA Environmental Health Clinician is responsible for personally discussing with each individual veteran the findings of the examination and completed diagnostic studies In addition each veteran will receive a followup letter explaining these finding and advising him or her of future actions or recommendations Operation Enduring Freedom veterans are not eligible

for the Gulf War Registry health exam and may not be included in the Registry However VA health care providers are equally concerned about the medical difficulties that those who served in Afghanistan have experienced and have welcomed concerned Afghanistan veterans to come to VA for a medical examination similar to that offered to Iraqi Freedom veterans Since 1998 VA has been authorized to provide a

broad range of health care services to US veterans who served on active duty in a designated theater of operations which would include Afghanistan Such veterans are eligible for 2 years after leaving the military for VA hospital care medical services and nursing home care for any illness even if there is insufficient medical evidence to conclude that their illness was a result of their combat service Dental services are not

included in the 2-year program What this means is that combat veterans have access to high quality health care at VA medical facilities for 2 years after their separation from military service based on their service in combat without having to prove that their health problems may be related to their combat service or to toxic exposures during their active service After the 2 years have ended the veteranrsquos copay-

ment status will depend on whether the medical condi-tion was officially found by VA to be service-connected or whether the veteran is otherwise qualified for care He or she will be enrolled in the appropriate priority group level For information regarding enrollment see www VAgovelig or contact the nearest VA medical center For locations of VA facilities consult the local

telephone directory under ldquoUS Governmentrdquo listings see wwwVAgov or call 877-222-VETS (or 8387) Additional questions should be sent as follows Mr Donald J Rosenblum Deputy Director Environmental Agents Service (131) Attn OIFEF REVIEW ndashQrsquos amp Arsquos Department of Veterans Affairs 810 Vermont Avenue NW Washington DC 20420 We will answer as many questions as possible

and will not identify the questioner Questions about personal medical problems are not generally considered appropriate for inclusion in the newsletter

Ionizing Radiation Fact Sheets Available One on Depleted Uranium A series of fact sheets known as ldquoIonizing Radiation

Briefsrdquo has recently been prepared and released by the Environmental Agents Service Each stand alone fact sheet covers an aspect or concern of veterans who were exposed to ionizing radiation Included among the Briefs is a 4-page fact sheet on

depleted uranium (DU) suspected by some individuals as the cause of some health problems experienced by some who served in the Gulf War or in Afghanistan Other available briefs provide general information on ionizing radiation describe the ionizing radiation registry discuss the VArsquos disability compensation program identify infor-mation resources on radiation health effects list illnesses linked to ionizing radiation and offer further information on related topics Readers can get the DU brief or any other or all avail-

able ionizing radiation fact sheets from the Environmental Health Coordinator at the nearest VA medical center or from the Environmental Agents Service (131) ATTN IR BRIEFS VA Central Office 810 Vermont Avenue NW Washington DC 20420 Also the Briefs are available online at wwwVAgovIrad

7

A For the answer we turned to Helen Malaskiewicz Senior ProgramManagement Analyst in the Environmental Agents Service and National Registry Coordinator She has been in that position for more than a decade According to Ms Malaskiewicz For Operation Iraqi

Freedom veterans the answer is definitely ldquoyesrdquo We encourage all Gulf War veterans which includes everyone who has served in the war in Iraq to contact the nearest VA medical center for an appointment Under the Registry program VA Environmental Health

Clinicians conduct a comprehensive physical examination Participating veterans are given the following baseline studies a complete blood count blood chemistries enzyme studies and urinalysis A chest x ray is taken if medically necessary Additional appropriate diagnostic studies are performed and consultants are obtained as indicated by the patientrsquos symptoms and physical and laboratory test result Laboratory and other finding are filed in the veteranrsquos permanent record maintained by the VA medical system In gathering each veteranrsquos medical history the

examiner records the time of onset of symptoms or conditions the intensity of symptoms or conditions the degree of physical incapacitation and details of any treatment received The examiner pays special attention to conditions and diagnoses that may be associated with service in the Operation Iraqi Freedom Following the examination the VA Environmental Health Clinician is responsible for personally discussing with each individual veteran the findings of the examination and completed diagnostic studies In addition each veteran will receive a followup letter explaining these finding and advising him or her of future actions or recommendations Operation Enduring Freedom veterans are not eligible

for the Gulf War Registry health exam and may not be included in the Registry However VA health care providers are equally concerned about the medical difficulties that those who served in Afghanistan have experienced and have welcomed concerned Afghanistan veterans to come to VA for a medical examination similar to that offered to Iraqi Freedom veterans Since 1998 VA has been authorized to provide a

broad range of health care services to US veterans who served on active duty in a designated theater of operations which would include Afghanistan Such veterans are eligible for 2 years after leaving the military for VA hospital care medical services and nursing home care for any illness even if there is insufficient medical evidence to conclude that their illness was a result of their combat service Dental services are not

included in the 2-year program What this means is that combat veterans have access to high quality health care at VA medical facilities for 2 years after their separation from military service based on their service in combat without having to prove that their health problems may be related to their combat service or to toxic exposures during their active service After the 2 years have ended the veteranrsquos copay-

ment status will depend on whether the medical condi-tion was officially found by VA to be service-connected or whether the veteran is otherwise qualified for care He or she will be enrolled in the appropriate priority group level For information regarding enrollment see www VAgovelig or contact the nearest VA medical center For locations of VA facilities consult the local

telephone directory under ldquoUS Governmentrdquo listings see wwwVAgov or call 877-222-VETS (or 8387) Additional questions should be sent as follows Mr Donald J Rosenblum Deputy Director Environmental Agents Service (131) Attn OIFEF REVIEW ndashQrsquos amp Arsquos Department of Veterans Affairs 810 Vermont Avenue NW Washington DC 20420 We will answer as many questions as possible

and will not identify the questioner Questions about personal medical problems are not generally considered appropriate for inclusion in the newsletter

Ionizing Radiation Fact Sheets Available One on Depleted Uranium A series of fact sheets known as ldquoIonizing Radiation

Briefsrdquo has recently been prepared and released by the Environmental Agents Service Each stand alone fact sheet covers an aspect or concern of veterans who were exposed to ionizing radiation Included among the Briefs is a 4-page fact sheet on

depleted uranium (DU) suspected by some individuals as the cause of some health problems experienced by some who served in the Gulf War or in Afghanistan Other available briefs provide general information on ionizing radiation describe the ionizing radiation registry discuss the VArsquos disability compensation program identify infor-mation resources on radiation health effects list illnesses linked to ionizing radiation and offer further information on related topics Readers can get the DU brief or any other or all avail-

able ionizing radiation fact sheets from the Environmental Health Coordinator at the nearest VA medical center or from the Environmental Agents Service (131) ATTN IR BRIEFS VA Central Office 810 Vermont Avenue NW Washington DC 20420 Also the Briefs are available online at wwwVAgovIrad

7

Whatrsquos New in Depleted Uranium andHealth bull Possible health problems from being exposed to

depleted uranium (DU) have been a controversy and a concern ever since DU was used in the 1991 Gulf War bull ldquoFriendly firerdquo casualties who have DU shrapnel

still in their bodies are being carefully followed at the Baltimore VA Medical Center DU Screening Program Other than the wounds caused by the shrapnel itself and continued high levels of DU in their urine so far no other health problems related to DU have been found in these veterans bull In 2000 the independent National Academy of

Sciences Institute of Medicine concluded that there was not enough scientific evidence to show that DU exposure caused any health problems for veterans of the 1991 Gulf War Their report can be seen at wwwnapedu bull Published scientific research on veterans from

the 1991 Gulf War has not shown any health effects to be clearly related to DU exposure even among veterans with retain DU fragments in war wounds (other than the sometimes very serious shrapnel wound itself) bull For veterans who are concerned about DU

exposure VA offers a DU urine screening test through the Baltimore VA Medical Center Every veteran of the 1991 Gulf War and the more recent conflicts in Southwest Asia is eligible for the DU screening program bull As of December 31 2004 VA has tested 327

veterans of the Gulf War for DU Only a few of these had slightly elevated urine uranium levels which appear to have no health significance bull Trace amounts of natural uranium are part of

our environment and all of us are exposed through food and water This background exposure can be detected as uranium coming out in urine But this is not considered to be a significant health concern except perhaps in a few areas that have unusually high levels of background uranium in drinking water bull The United Nations Environment Programme is

reported to be studying a number of sites in Iraq This group has published three studies examining DU use in the former Yugoslavia and concluded that ldquoThe levels of DU contamination were not a cause for alarmrdquo bull The World Health Organization 2003 DU fact

sheet stated that there is ldquoinadequateinsufficientrdquo evidence of DU health effects in humans in previous conflict zones

bull Not all DU health questions have been conclusively resolved although the bulk of past clinical evaluations and research has not shown it to be a major health risk Therefore the DU testing program in Baltimore will continue indefinitely

bull The latest report to Congress on Federal Sponsored Research on Gulf War Veteransrsquo Illnesses for 2002 listed ten studies on DU

About the ldquoReviewrdquo The ldquoOIF and OEF Reviewrdquo is produced by

VArsquos Environmental Agents Service (EAS) to provide information on long-term health and other concerns of Operation Iraqi Freedom and Operation Enduring Freedom veterans their families and others The ldquoReviewrdquo describes actions by VA and other Federal departments and agencies to respond to these concerns and gives updates on a wide range of VA programs for veterans For other issues of this newsletter and related information regarding the current conflict in Iraq please see our Web site at wwwVAgovGulfWar EAS anticipates publication once or twice a

year depending on the amount of news on this subject and on budgetary considerations This issue was completed in early February 2005 It does not include developments that occurred after that time Comments questions and suggestions for

future issues are encouraged and can be sent to the Gulf War Review Donald J Rosenblum Deputy Director Environmental Agents Service (131) VA Central Office 810 Vermont Avenue NW Washington DC 20420 Requests for additional copies of this andor

future issues should also be sent to Mr Rosenblum Supplies are limited Please specify the quantity and issue date requested

Clarification The earlier issues of this publication included stories

on the 2-year rule for recent combat veterans Under this rule military veterans who served in a combat zone or area of hostilities comparable to that seen during combat are eligible for 2 years of free medical care from VA for many conditions That is to say veterans do not have to prove that a medical problem is connected to their military service to receive free VA care for that condition nor must they have relatively low incomes We want to clarify that the benefit does not cover

treatment for medical problems clearly unrelated to military service and disorders that existed before the person joined the military unless the condition worsened during military service Furthermore while the article correctly reported the

above information it neglected to explain that dental care eligibility is totally different from medical care and

88

______________________________

_____________________

that dental services are not covered by the 2-year rule We regret any problems that our omission may have caused

Information on VA DisabilityCompensation Like all veterans Operation Iraqi Freedom and Opera-

tion Enduring Freedom veterans may be eligible for monthly payments called disability compensation from VA if they are suffering from service-connected illnesses or injuries The disability must have happened or made worse during active military service Furthermore the veteran must have left military service through separation or discharge under conditions that were other than dishon-orable Disability compensation varies according to the degree

of disability and the number of dependents Benefits are not subject to Federal or state income tax The receipt of military retirement pay disability severance pay and separation incentive payments know as SSB and VSI (Special Separation Benefits and Voluntary Separation Incentives) also affects the amount of VA compensation paid The disability ratings range from 0 to 100 percent (in

increments of 10 percent) For example in 2005 an OIF or OEF veteran with a disability rating of 10 percent receives $108 a veteran with disability rating of 50 per-cent gets $646 and a veteran who is totally disabled and evaluated at 100 percent receives $2299 monthly Veterans with disability ratings between 30 and 100

percent are also eligible for monthly allowances for a spouse ranging from $39 to $130 and for each child $19 to $66 (The amount depends on the disability rating) A veteran who is in need of regular aid and attendance

of another person or who is permanently housebound may be entitled to additional benefits VA must make that determination before the veteran can get these benefits Additional information including online applications can be seen at wwwVAgov

Must Apply to be Considered Compensation is not automatically provided to the

OIF OEF or other veterans VA veterans service rep-resentatives (VSR) can provide the necessary applica-tion and assist veterans who need help in completing it VSRrsquos are located at all VA Regional Offices in VA medi-cal centers and at most VA clinics For help in locating a VSR near you call the following toll-free telephone number 1-800-827-1000 or go online at wwwVAgov

Other Benefits In addition to the compensation program described

above individual OIF and OEF veterans may be eligible for the full range of other benefits offered

by VA including education and training vocational rehabilitation home loan guarantees life insurance pension burial benefits and more To learn more about VArsquos programs OIF veterans and

other interested parties can visit the VA home page www VAgov or call 1-800-827-1000 This information was provided by benefit experts in the

Veterans Benefits Administration in VA Central Office

Address Changes and Duplicates If this newsletter has your old address please use

this form to update our mailing list Send the completed form to the Gulf War Review AustinAutomation Center (200397A) 1615Woodward StreetAustin TX 78772-0001 If you have access to the Gulf War Review via the VA Web site wwwVAgovGulfWar and wish to discontinue receiving a copy by mail please complete the above form and return it to the Austin Automation Center If you are receiving more than one copy of the newsletter please let us know Write to the address above Please provide your name address and social security number Thank you

Check or circle the language that describes your situation

____My address has changed and I would like to continue to receive the newsletter

_____I am receiving more than one copy but I only want to get a single copy

_____I donrsquot need to get the newsletter by mail as I can read it at wwwVAgovGulfWar

_____Other (explain)_________________________

Please print yourFirst Name ________________________Middle ___________________________Last ______________________________SSN _____________New StreetRFDMilitary Unit __________________

APOFPO ____ (Indicate which if applicable)City ____________________Alpha Stateor APOFPO Code ___ZIP Code ________

9

WRIISCs Are Ready to Help OIF and OEF Combat Veterans VArsquos War Related Illness and Injury Study Centers

(WRIISCs) provide service to combat veterans who have difficult-to-diagnose disabling illnesses though clinical care risk communication education and research that focuses on the potential environmental exposures and adverse health outcomes The Centers replaced the Gulf War Referral Centers

several years ago expanding their mission to offer comprehensive clinical care to combat veterans of all eras The two current centers are located at VA medical centers in Washington DC and East Orange New Jersey Center officials work closely with Department of Defense personnel who are performing similar post-deployment health issues for active duty service members and veterans Once a diagnosis is determined treatment based on the WRIISCrsquo s conclusions is provided by the VA medical center that referred the veteran The WRIISCs were set up to respond to the health

problems of veterans from both past and future conflicts Improving the care of patients with war-related conditions require the same scientific rigor American health scientists have applied to other important problems Some veterans have persistent unexplained

symptoms following deployment to a combat zone Individual veterans who have completed a thorough medical evaluation at their local VA medical center may be eligible for an in-depth examination and evaluation at one of the WRIISCs VA primary care providers of veterans with undiagnosed illnesses can request an evaluation at one of the WRIISCs The referral process is coordinated by VA Central Office Referral acceptance is a joint decision of VA Central Office the WRIISCs the referring providers and the patient More than 750 individuals have been treated at the two WRIISCs during the past 3 years Veterans may not refer themselves Patients

interested in a referral should work through their VA health care provider For additional information see wwwVAgovEnvironAgents or call 1-800-PGW-VETS (1-800-749-8387)

Delays Enable Increased Printing and Distribution of Newsletter The headline of the lead article of the June 2004 issue

of Operations Iraqi FreedomEnduring Freedom (OIF OEF) Review declared that it was being mailed directly to approximately 136000 recently returned veterans of the wars in Iraq and Afghanistan The article was true when written but an interesting and unusual thing hap-pened since its preparation The roster of Gulf War and Afghanistan returned veterans continued to grow and reached about 180000 before the newsletter was distrib-uted In response VA printed and mailed tens of thou-sands of additional copies Future issues are likely to go to even more veterans In addition copies of all issues of this newsletter

are continuing to be sent to all VA medical centers VA regional offices vet centers veterans service organiza-tions and other interested groups and individuals Anyone who wants back issues and future editions of

the newsletter can get them at wwwVAgovGulfWar Copies of these newsletters are continuing to be listed under Gulf War Review a separate newsletter also prepared by VArsquos Environmental Agents Service in Washington DC The address for the Environmental Agents Service is

Environmental Agents Service (131) VA Central Office 810 Vermont Avenue NW Washington DC 20420 The office can also provide you with additional copies if available

1010

Where to Go for Information and AssistanceActive duty military personnel with questions

or concerns about service in Southwest Asia (including Operations Desert Storm Desert Shield Iraqi Freedom and Enduring Freedom) - contact your commanding officer or call the Department of Defense (DoD) Gulf War Veteransrsquo Hotline (1-800-796-9699) for information DoD also offers the ldquoDirect Veterans Hotlinerdquo with the toll-free number 1-800-497-6261 Any Gulf War veterans (Included Operations

Desert Shield Desert Storm and Iraqi Freedom veterans) with concerns about their health should contact their nearest VA medical center The telephone number can be found in your local telephone directory under Department of Veterans Affairs in the ldquoUS Governmentrdquo listings Medical care is available and a Gulf War Registry examination for veterans who served in Iraq is also available on request The VA Gulf War Information Helpline can also

provide information and assistance The toll-free telephone number is 1-800-PGW-VETS (1-800-749-8387) Check our Web sites for more Gulf War

information on health care and other benefits (including those for Operations Iraqi Freedom Desert Shield and Desert Storm veterans) at www VAgovGulfWar Gulf War veterans in need of maritalfamily

counseling should contact the nearest VA medical center or VA Vet Center also listed in your phonebook under Department of Veterans Affairs in the ldquoUS Governmentrdquo listings For additional information about these programs call the Gulf War Information Helpline at 1-800-PGW-VETS (1-800-749-8387) Gulf War veterans seeking disability compensation

for illnesses incurred in or aggravated by military service can contact a Veterans Benefits Counselor at

the nearest VA regional office or health care facility at 1-800-827-1000 or call the VA Gulf War Information Helpline at 1-800-PGW-VETS (1-800-749-8387) You can also start a claim online at www VAgov Gulf War veterans interested in learning about the

wide range of benefit programs administered by VA should contact a Veterans Benefits Counselor at the nearest VA regional office or health care facility at 1-800-827-1000 or call the VA Gulf War Information Helpline at 1-800-PGW-VETS (1-800-749-8387) Representatives of veterans service organiza-

tions including the American Legion (1-800-433-3318) Veterans of Foreign Wars of the United States (1-800-VFW-1899) Disabled American Veterans (1-877-426-2838) etc have been very helpful to Gulf War veterans especially veterans who are seek-ing disability compensation (These organizations are cited as examples There are many other excellent organizations VA does not endorse or recommend any one group over another) County Veterans Service Officers also have been

of great help to many military veterans including those who served in the Gulf War who are seek-ing benefits they earned through their service to the Nation For additional Federal benefit information see

VArsquos Federal Benefits for Veterans and Dependents booklet It is updated annually to reflect changes in law and policies It is available for purchase from the US Government Printing Office Superintendent of Documents Washington DC 20402 Web site bookstoregpogov VArsquos World Wide Web pages are updated throughout the year to present the most cur-rent information The VA home page (wwwVAgov) contains links to selections on compensation and pen-sion benefits health care benefits and services burial and memorial benefits etc

11

12

Department ofVeterans Affairs Central Office (131) 810 Vermont Avenue NW Washington DC 20420

OFFICIAL BUSINESSPenalty for private use $300

ope rations iraqi freedom enduring freedom review Information for Veterans Who Served in Iraq and Afghanistan and Their Families February 2005